MEDICARE: MS. DALE MARIE HAMPTON LABOHN B.S.H.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner		NV

General Provider Information

NPI Number	:	1497014708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DALE MARIE HAMPTON LABOHN B.S.H.S.

Provider Business Mailing Address
First Line	:	9328 MOUNTAIN RISE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7820
Country	:	US
Telephone Number	:	908-674-1729
Fax Number	:

Provider Business Practice Location Address
First Line	:	9328 MOUNTAIN RISE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7820
Country	:	US
Telephone Number	:	908-674-1729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	05/07/2012

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